PURPOSE
Patients with obesity who are admitted to an ICU bring specific challenges for rehabilitation during and after critical illness. This narrative review explores impact of differences in body compositions and pathophysiology on outcomes to summarise interprofessional, patient-centred rehabilitation strategies across the trajectory of recovery.
METHODS
The interprofessional expert panel reviewed major trials and guidelines, integrating their clinical expertise with the current evidence.
RESULTS
Three distinct phenotypes potentially influence outcomes for survivors. Whilst patients with preserved muscle mass may have a survival advantage, the phenotypes characterised by ectopic visceral fat or sarcopenia are frequently complicated by multimorbidity and polypharmacy, likely increasing the risk of adverse effects such as suboptimal sedation, prolonged ventilation and immobilisation, malnutrition, and impaired recovery. Targeted respiratory interventions, including secretion-clearance techniques and appropriate patient positioning to prevent atelectasis, reduce the work of breathing. Optimisation of communication and swallowing function is an essential component for facilitating safe oral intake and promoting active patient participation in rehabilitation. Concurrently, targeted nutrition strategies combined with early, targeted, progressive mobilisation might mitigate ICU acquired weakness and support functional recovery. The availability of appropriate weight‑based equipment is fundamental to ensuring safe mobilisation for both patients and healthcare professionals.
CONCLUSION
Interprofessional collaboration is central to optimising outcomes and should extend beyond the ICU to structured post-ICU follow-up to address persistent, worsening, or newly emerging health impairments. Early rehabilitation in critically ill patients with obesity should integrate physiological, logistical, and psychosocial considerations to support equitable and functional recovery.
Sabrina Eggmann, Danielle E. Bear, Richard S. Bourne et al.· Intensive Care Medicine· 0 citations
INTRODUCTION
Survivorship after critical illness is frequently complicated by muscle wasting and gastrointestinal (GI) dysfunction, driving prolonged functional impairment. Nutrition is a modifiable determinant across the intensive care unit (ICU)-to-home continuum, yet delivery is commonly limited by feeding intolerance and fragmented transitions of care.
AREAS COVERED
This expert opinion review synthesizes evidence identified via a narrative search of MEDLINE/PubMed and key guideline/reference screening, focusing on GI dysfunction as a barrier to enteral nutrition (EN) in the ICU, phase-adapted energy and protein provision, and strategies to restore intake during ward recovery and after discharge, including high-energy, protein-dense oral nutritional supplements (ONS).
EXPERT OPINION
Nutrition should be delivered as a structured pathway rather than a single ICU intervention. Early EN with proactive, symptom-targeted management of GI dysfunction, coupled with stepwise protein escalation aligned to metabolic phase and organ function, may help reduce avoidable deficits. The early post-ICU period is an anabolic 'window of opportunity' that warrants intake monitoring, deliberate tapering of tube feeds only once oral intake is reliable, and routine post-discharge ONS for patients at nutritional risk. Research should prioritize pragmatic trials of phase-specific targets and transition-of-care models.
A. V. van Zanten, Pavel Kohout, Elisabeth de Waele et al.· Expert Review of Gastroenter...· 0 citations
Clinicians should recognize the post-ICU hospitalization period as a potential 'metabolic danger zone', requiring a shift from acute-phase restrictive feeding toward strategies prioritizing functional recovery and lean mass preservation.
O. Leemans, Zenzi Rosseel, C. Pichard et al.· Current Opinion in Critical...· 0 citations
